Integration Support

Ventura Center for Advanced Therapeutics

Ketamine Clinic & Anesthesiologist located in Camarillo, CA

At Ventura Center for Advanced Therapeutics in Camarillo, California, Dr. Stefany Wolfsohn and her dedicated team make the latest, safest, most effective treatments available to their patients. Psychiatric indications for ketamine therapy include but are not limited to: major depressive disorder and associated suicidal ideation, depression subtypes, post-traumatic stress disorder, generalized anxiety disorder, obsessive compulsive disorder, social anxiety disorder, bipolar disorder, substance use disorder, eating disorder and mood disorders related to patients in palliative care. Integration support following ketamine treatments may be more important than the ketamine treatment session itself.

Integration Support Q & A

What is Integration?

Ketamine treatments can be a time for deep revelation and profound non-ordinary experiences. These experiences may feel exciting, expansive, confrontational, or even existential while they are happening. Afterward, patients can have difficulty figuring out what to do with this new information, how to make meaning of it and create new perspectives and take action. Professional psychedelic integration services can be done in an individual or group setting and may involve your own licensed therapist or trained psychedelic coach. Dr. Stefany Wolfsohn is able to provide additional integration support to patients who do not have these services established prior to starting ketamine therapy.

  Tarot card of The Fool by Siolo Thompson

https://siolothompson.com/linestrider-tarot

Like any new endeavor, your ketamine journey begins with preparation. Have you learned enough about ketamine to start the process? What are your expectations of this treatment? Along the way, you will likely encounter parts of yourself you either did not know existed or parts that may have been suppressed for a long time. Even though you might be unaware of them, these parts can still influence your life and cause problems or make you feel “stuck".

Are you willing to be curious and invite these parts of you out so that you can work with yourself to heal and make changes in your life? Are you willing to let go of old thought patterns to make room for new ones? Being vulnerable may seem scary at first; however, entering a ketamine journey with this state of mind is helpful in creating long-term sustainable change.

  Tarot card of Temperance from Ostara Tarot

https://tarotgarden.com/ostara-tarot/

Is your external environment prepared for change? Are your loved ones or caregivers prepared for your ketamine journey? What needs to be said to them before going into a ketamine treatment? What do you need emotionally and physically before you arrive to your appointments and afterwards?

Information about internal and external preparation for ketamine therapy is discussed and given to each patient in writing to help prepare for the ketamine journey and the integration work that follows.

  Tarot card of The Creatrix by Liz Huston

https://www.lizhuston.com/

Ketamine therapy has the potential to do more than reduce symptoms for a set period of time. It creates a window of opportunity for personal growth and transformation. Integrating information from your treatment experiences into everyday life is a significant part of your journey. This is when the real work begins and people discover their own capacity for healing. There may be ups and downs along the way. It can be challenging to understand new insights and to make behavior changes.

  Tarot card of A Leg Up by Colette Baron-Reid

https://www.colettebaronreid.com/

There are several activities that patients are encouraged to do between ketamine treatments to help themselves do integration work. Some patients audio record their conversations with therapists during treatment in order to listen to their own voice and insights from the medicine session in the days to weeks following treatment. Journaling, drawing, painting or doing an activity outside in nature after treatments can be very therapeutic. Music, meditation and dance can also help connect mind, body and spirit.

Patients are offered additional integration support either with Dr. Wolfsohn or with other licensed practitioners and/or coaches with additional training in psychedelic medicine. Each practitioner uses modalities and techniques within their scope of practice.

  Tarot card Nine of Cups by Liz Huston

https://www.lizhuston.com/

The ketamine medicine session is a self-directed experience that can at times, feel like a lucid dream. The medication, the treatment space and the individuals involved in your care are there to help you feel safe and supported while you are doing the work to heal. Patients can become more self-aware of old and rigid negative beliefs and start to question whether these beliefs are helping or hurting them now. They can confront past traumas or difficult emotions and experience a positive shift in their perspective about it.

Not all information revealed during a ketamine treatment is understood immediately; however, observing and making note of it in a non-judgmental way is helpful during the integration process.

  Visual art of hummingbird by Cameron Gray

https://parablevisions.com/biography/

Imagination is also part of the spectrum of experiences with ketamine treatments. By allowing your active imagination to play during this period of time, you will help cultivate creativity. Creativity enhances connections and communication between different areas in the brain which can reduce stress and promote a better sense of physical health and well-being.

  Paint of woman by Carmen Cassandra Sorrenti

https://www.carmensorrenti.com/

In our practice, we have begun to look at symbols and images with patients during the integration process to help develop creative imagination, explore new insight and perspectives and to make changes in life. This methodology was developed by Lauren Z. Schneider, MA, MFT and is part of a larger psychotherapeutic practice known as Tarotpy®. Dr. Wolfsohn along with several other ketamine psychotherapists affiliated with her practice continue to learn this modality from Lauren to strengthen our own inner resources which indirectly complements the work we do every day with ketamine patients.

  Paint portraying strength by Carmen Cassandra Sorrenti

https://www.carmensorrenti.com/

We have found that using symbolic imagery with patients can deepen a person's ability to understand the information that is revealed during ketamine treatments. This often helps them to talk about difficult issues and work towards finding creative solutions.

The images used often come from Tarot cards, soul cards, oracle decks or other playing cards used as psychotherapeutic tools; not as a means to predict the future. If you have read this far down the page, hopefully you have noticed some examples of Tarot and oracle cards that have been used with patients already for integration. These digital images portrayed are for educational purposes. For more information about Tarotpy® please ask when you come in to the office or visit: https://www.dreamsandtarotpy.com/

Integration conversations using picture cards

Both ketamine therapy and Tarotpy®, when used independently, are potent tools to awaken the imagination and gain new insight and perspective. We have found that using the two modalities together within a short period of time can help patients achieve greater self-awareness and a greater capacity to discuss difficult issues with therapists and/or loved ones.

Here are some examples of a short exercise I have done either before or after ketamine treatments or during a separate integration appointment with patients. Patients were asked to choose a caption to describe each problem or idea that was on their mind at the time of this activity. The short version of this exercise usually involves looking at 1-3 images. Patients were given multiple card decks to find an image that best fits above each caption. Cards were laid out in whichever order or shape they wanted. Patients usually selected their cards after looking through different images within the decks; however, cards can also be shuffled, randomly selected and placed face down before looking at them. The images were discussed in whichever order the patient wanted; usually beginning with the card that they were drawn to the most.

Patient One

  Photograph of man with his arms tied with an umbrella on his back, by Nicolas Bruno

Source: https://www.somniatarot.com/

My Depression
  Visual art of a flamingo with half of the content grayed out and the caption Between Worlds, by Colette BAron-Reid

Source: https://www.colettebaronreid.com/

Coming out of Ketamine

Although this patient is an adult in his 30's, his parents had to do most of the talking for him in the first meeting. Initially, he had poor eye contact and did not want to speak with me about his depression. He had almost given up hope on finding anything to relieve his symptoms. After a few ketamine treatments, he started to feel better. He began to open up more and share some of the thoughts and emotions he was unable to verbalize prior to starting ketamine. Over time, we started to look at pictures and have more conversation after his ketamine infusions. Here's what came up the first time we looked at images:

I can't see. I can't think. I can't do anything. I don't know if I should fall in and let myself drown or if I should just jump in and drown and be done with it. That would make life easier for everyone.

My Depression

Hopeful. My head can reach above the clouds. The world has color again. It is beautiful. Is this what it looks like for people who aren't depressed?

Coming out of Ketamine

On subsequent treatment days, this patient walked into the office with a more animated greeting and a new enthusiasm about what was going to come up during that ketamine treatment. He was more willing to discuss how his depression has negatively impacted his outlook on life, work opportunities and relationships with loved ones. He continues to work with his therapist to make changes to improve the quality of his life.

Patient Two

  Tarot card of Swords, by Ciro Marchetti

Source: https://www.ciromarchetti.com/

Childhood
  Tarot card 6 of cups, by The Light Seer's Tarot

Source: https://lightseerstarot.com/

Anger
  Card portraing an apology, from the series of Metaphoric Cards by The OH Cards Institute

Source: https://oh-cards.com/

Closure

During this patient's initial ketamine treatment series, he noticed he was becoming more confrontational during visits with his elderly and dying father to the point that he would explode and stop talking to him for several days at a time. Following these arguments, the patient would also binge drink and spiral down into a path of guilt and self-loathing. We decided to look at some images to help describe what he was feeling and what he could do to make things better. In this case, the images were chosen first and the captions were created second. We looked at two images “Anger” and “Childhood” before deciding to choose a third image to help the patient come up with a possible solution.

On Anger... “Every time I see a dad out playing with his son, it makes me angry and I want to hit something. I am jealous of how happy they look. I feel like a horrible person for even saying that. I hate my dad for what he did to our family. I don't think he even realizes how much he screwed me up. It is because of him that I don't want to ever have kids. I would not be a good father” .

The patient described the man in the image as someone who is scared and hiding in the dark. He said “the man in the image is trying to protect himself with armor and swords” . The patient described his childhood as one big lie that he had to protect himself from. Growing up in a small town, his parents were public figures in all aspects of the community. To the outside world, they painted a picture of the perfect happy family; however, inside the home was a different story. From a very young age, his father would ask him to keep secrets from his mother about his extra-marital affairs and poor spending on multiple bad investments. Everyone in the community knew about it except his mother. The patient was not allowed to express any negative emotions about his father's behavior without repercussion. His father had a bad temper and there had been multiple instances where verbal altercations became physical.

The images used did not necessarily show the patient anything he did not already know; however, with the help of using imagery right after a ketamine treatment, he seemed more willing to discuss his recent behavior toward his father and engage with the process of understanding the source of his anger and shame and to start to come up with ideas for what he could do about it.

I prompted him to choose a third card that could represent a way to approach his father about his anger. He chose from a deck that actually has two decks, one with words and the other with pictures. He chose to combine the “Apology” verbal card and the watercolor image of two people hugging to represent what he needed most from his father right now. He wanted his feelings to be validated and to hear some form of an apology from him. The patient continues to work with his therapist on healing this parent-child relationship. Interactions with his father have gradually improved. There have been no recent episodes of binge drinking.